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to jm jm

Would you say a person with the following test result can stop worrying?

Neg antibody 12 weeks after a low risk exposure
Neg Riba 18 weeks after exposure, screening test was 1.0.
Neg pcr qualitative, 18 weeks after exposure.
Neg antibody 28 weeks after exposure.

A yes or no is all I need.  Many thanks.

I believe i know the answer.  i only want to hear it from someone more knowledgable than I.
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Avatar_m_tn
Given the expsure was "low risk" I don't think any reason to worry, however, you might want to do a sensitive qualitative (or  sensitive quant) to be sure either now or in a couple of months -- although the week 18 test should give you a degree of confidence.

-- Jim
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Avatar_m_tn
But do you think i am in the clear?
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Avatar_m_tn
the pcr test was from lab Corp.  The qualitative is more sensitive than the quantitaive, I believe.  probably because qual checks for the presence or absence of Hcv NOT the amount of Hcv.
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Avatar_m_tn
Yes, I think you're OK, but I don't think anyone can guarantee you 100% at this point, and of course I'm not a doctor.

So, if it were me, I'd relax in the knowledge that things look very good, and then re-test using a senstive TMA in another couple of months.

If you need further assurance or peace of mind, you might go here and ask one of the hepatologists who I believe still take questions. Hopefully they have the timelines down cold. And of course, run same by your own doctor.
http://www.hivandhepatitis.com/hep_c.html

Jak:  The qualitative is more sensitive than the quantitaive, I believe.
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Often but not always.

Labcorp actually has a very sensitive quantitative called Quantasure that goes down to 2 IU/ml. Not sure what the sensitivity of their qualitative is.

Quest also has a very sensitive quantitative called "Heptimax" that goes down to 5 IU/m. They also have a sensitive qualitative called "HCV RNA TMA QUALITATIVE" that also goes down to 5 IU/ml. That's the test I took post treatment.

Any of the tests mentioned would be OK, although I think in your case I'd favor the "HCV RNA TMA QUALITATIVE" over Heptimax if you went with Quest. If you go with LabCorp, the best for you would be their "Quantasure".

-- Jim

-- Jim
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Avatar_m_tn
I think you may already know this but only 3% of people dont have AntiBodies by week 26. Most of them are immune compromised. So no HCV-AB @week 28 =no HCV unless you have HIV or otherwise immuno suppresed.
CS
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Avatar_m_tn
Clicked Post Comment too soon
Jakied - Neg pcr qualitative, 18 weeks after exposure
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This means you DONT have hepC regardless of the other tests.
The virus can be detected by PCR well B4 AntiBodies appear.
CS

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Avatar_m_tn
CS: The virus can be detected by PCR well B4 AntiBodies apppear
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Shiffman has a different take on this and states that viremia can be intermittent during the acute phase, i.e. move in and out of the detectible range. So while I do agree that Jakied is most probably in the clear -- esp since the exposure was not high risk -- the prudent thing would be to follow up.

(See Slide 9) (Free Registration Required)
http://webcasting.clinicaloptions.com/p41111200/

Cont...

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Avatar_m_tn
That "3 per cent" figure should be assuring in the general context. I've never seen it broken down like that. Do you have a link to a study or paper?
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From Slide Presentation cited above:

This next slide looks at the biochemical and virologic response of patients exposed to HCV. In the green line you can see acute elevation in liver transaminases within the first couple of weeks after exposure to the virus, indicating acute HCV infection. Notice in the red bar I have indicated presence or absence of HCV RNA. During the acute phase of HCV infection, if you test for HCV, sometimes the virus will be detectable, but at other times the virus is undetectable. Because of this intermittent viremia, virologic assays are not the best assays to screen for acute hepatitis C.

   Over the next couple of weeks of infection, liver transaminases decline and then go into an undulating pattern over the next 1-1.5 years, when the serum alanine aminotransferase (ALT) can fall into the normal range for either brief or prolonged periods of time, only to elevate again. This shows that individuals with chronic hepatitis C can have both elevated liver enzymes and normal liver enzymes, and sometimes they can have persistently normal liver enzymes for long periods of time. However, these individuals will test positive for antibodies to hepatitis C and, if they have chronic infection, will be viremic.

  The blue line indicates an individual who had spontaneous resolution from hepatitis C. Again, you see acute elevation of liver transaminases during the acute phase, intermittent viremia in the first couple of weeks after the infection, and then the liver transaminases coming down and remaining persistently normal. It is important to recognize that individuals who have been exposed to HCV but develop spontaneous resolution will also develop antibodies to hepatitis C. This is the type of individual who may go and donate blood to a blood bank and have a positive antibody for hepatitis C or be noted as having a positive antibody on life or health insurance physical exams. However, they have persistently normal liver enzymes, and when tested for HCV RNA, they are virus undetectable.    
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Avatar_m_tn
Both of you have given me a lot of peace.  My risk factor was protected sex with a pros and my mind was playing tricks on me.

Dr H, on the hiv forum, said I was definitely neg so i won't worry anymore.  A nice way to end 2007.

many thanks to you both.
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Avatar_m_tn
I'm glad you got such a quick and positive response from the doctor at the  HCV/HIV forum. That should take quite a load off your mind.
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Avatar_m_tn
The Following comes from NIH
Hepatitis C can cause both acute and chronic hepatitis. Knowledge of the course and
outcome of infection arises largely from studies in chimpanzees and previous post-transfusion
and more current post-needlestick accident cases of hepatitis C. In acute hepatitis, HCV RNA
can be detected in the serum within one to two weeks after exposure, rising thereafter to levels of
105 to 107 viral genomes per ml. Serum alanine aminotransferase (ALT) levels indicative of
hepatocyte injury and necrosis start to rise 2 to 8 weeks after exposure and usually reach levels
of greater than 10 times the upper limit of normal. About one-third of adults with acute HCV
infection develop clinical symptoms and jaundice, the symptomatic onset ranging from 3 to 12
weeks after exposure. In self-limited acute hepatitis C, symptoms last for several weeks and
subside as ALT and HCV levels fall. Acute hepatitis C can be severe and prolonged but is rarely
fulminant. Antibody to HCV as detected by enzyme immunoassay (EIA) arises at the time of or
shortly after onset of symptoms, so that 30 percent of patients test negative for anti-HCV at onset
of symptoms, making anti-HCV testing unreliable in diagnosis. Almost all patients eventually
develop anti-HCV, although titers can be low or even undetectable in patients with immune
deficiencies.

The following comes from AASLD PRACTICE GUIDELINES
Diagnosis Management and Treatment of Hepatitis C

There are instances in which a negative anti-HCV does not exclude HCV infection in patients with suspected liver disease. These include acute HCV infection or immunosupressed states. HCV RNA testing can be used to establish acute HCV infection after an exposure because HCV RNA
can be detected in 1 to 2 weeks while antibodies to HCV are detectable an average of 8 weeks later 25-27. HCV RNA testing can also be used to test for HCV infection in persons with negative
HCV antibody results who are known to have conditions associated with diminished antibody production, such as HIV infection and chronic hemodialysis

And finally
Infection is followed by a rapid rise in serum HCV RNA and levels peak within 6-10 weeks. The ALT levels rise approximately 40-50 days after infection. Most patients do not develop symptoms with acute HCV infection. If the patient develops symptoms, they appear about 8 weeks after exposure and last for 2 to 12 weeks. Anti-HCV antibodies typically become detectable between 7 to 8 weeks after infection, but they may play a limited role in clearance of the virus. This graph shows persistence of hepatitis C viremia.
In most individuals, anti-HCV antibodies appear 7 to 8 weeks after exposure [8]. Antibodies may appear slightly later after transfusion-related infection than after other modes of HCV transmission [5]. Greater than 80%, 90%, and 97% of patients demonstrate anti-HCV by 15 weeks, 5 months, and 6 months, respectively [1]. Notably, up to 3% of patients with chronic hepatitis C may never seroconvert .

Notice the 97% and 3% figures above.

Sometimes jim me thinks you like an argument.
The shiffman slide only occurs rarely and when it does ABs will be present. It was clear Jakied didnt have HCV with all those tests unless he had HCV or on hemodialysis
CS


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Avatar_m_tn
Below is the link the 3rd paragraph came from. Paint a differnt VL grapg than Shiffman does.
http://depts.washington.edu/hepstudy/hepC/clindx/acute/fig1d.html
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Avatar_m_tn
Congrats on not Having HCV. You probably should learn not to worry so much ay -lol.
Anyway wish you well
CS
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Avatar_m_tn
Should learn to spell ay. grapg=graph
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Avatar_m_tn
Thanks for link and discussion, or what you might characterize as "argument'. And no, I don't think our advice differed much to "Jakied" but the Shiffman presentation was clear that viral load testing might not be the most effective tests for acute HCV. It's not surprising that different studies paint different pictures. So, if it were me pesonally, or a family member -- I would have the test repeated down the road. And so I advised Jakied. That's quite different from inferring that he should worry about it.

-- Jim
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Avatar_m_tn
Just a bit tiered so sorry.
The VL is the first thing that you can detect, after that Shifman may be right just always thought it was rare. By 12 weeks and difinately by 6 months almost all will have ABs, so probably best to do both tests.
CS
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Avatar_m_tn
You are both wonderful to help me.  Sometimes I worry too much.  I definitley DO NOT have Hiv or Hbv so i am not immunocompromised.  Normal Liver function, alt 42, range up to 55, ast 28, range up to 40, bilirubin .9 and albumin 4.9.  

How are you two doing?  Are either or both of you on treatment now?  Anyway, I wish EVERYONE with Hcv would hear the magic words, 'Svr.'

Many thanks to you both.
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Avatar_m_tn
Yes, you are right.  i need to stop worrying about this.  May I ask if you are Hcv pos?  If so, i hope you are surviving treatment.  I hope you hear the magic words, 'Svr' VERY soon.

Merry Christmas
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Avatar_m_tn
Nah not on Tx. G3a and failed twice.

Merry xmas back to ya.
Have a happy and HCV free new year.
CS
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Avatar_m_tn
I had a scare with Hcv in sept '05.  The next 4 months were hell.  On my 15 week test, the screening result was a 1.0 which is the beginning level for reactive.  waiting for the Riba test over that new years weekend was the worst 4 days of my life.  I was so scared but the lady on the phone said 'your Riba is neg.'  To be sure about this, i took the Pcr qual.  That was also neg.  I have since learned that less that 1% of Riba neg patients are Pcr pos.  Anyway you and Jim gave me a lot of peace of mind.  And for that I am grateful.

I say a prayer for all the 'heppers' every day at Mass.

is there any chance of a breakthrough treatment in 08 or 09?
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Avatar_m_tn
At least you havnt had the joy of being told you have HepC. Scared the shite outa me thought i was dead. Took a while to get over the Dx i can tell you. Now i know that if you have to have a disease that can kill you HepC is not a bad one to have. At least for the first 20-30 years. I had HCV 25 years or so and have no intention of taking a long term nap just yet.

Enjoy Xmas
CS
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Avatar_m_tn
What are the chances of a breakthrough treatment in 08 or 09?  What i don't like is how Hiv gets all the good pub while Hcv gets no or bad pub.  that makes a diff in funding etc.
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